抗酸杆菌自动荧光染色和显微镜扫描技术在结核病诊断中的临床评价

Clinical value of automatic fluorescence mycob. T stainer and scanner for detecting tuberculosis

目的观察自动荧光染色和显微镜扫描技术检测结核分枝杆菌的临床价值。方法2016年9-12月，在临沂市人民医院门诊连续纳入了748例疑似肺结核患者，收集2243份痰标本。每份痰标本制作2张涂片，一张采用传统荧光染色法，并用传统荧光显微镜（fluorescence microscopy，FM）人工阅片。另一张用自动荧光染色和显微镜扫描技术（AFSS）进行染色和扫描。所有样品经4％NaOH消化处理，然后接种到罗氏培养基中进行分离培养。与培养结果相比，分析AFSS的效能。所有AFSS和传统FM检测结果有差异的涂片采用萋一尼染色显微镜检查方法进行复核。结果AFSS检测的阳性率为32．1％（720／2243），常规FM检测的阳性率为31．92％（716／2243），两者比较差异无统计学意义（χ2=0．016，P〉0．05）。与罗氏培养相比，AFSS检测分枝杆菌的敏感度和特异度分别为83．4％（657／788）和95．9％（1386／1446）。阳性预测值和阴性预测值分别为91．6％（657／717）和91．4％（1386／1517）。结论AFSS检测分枝杆菌的敏感度和特异度较高，自动化程度高，值得推广应用该技术。

Objective To observe the clinic value of automatic fluorescence Mycob. T Stainer and Scanner （AFSS） for detecting tuberculosis. Methods A total of 2243 sputum specimens from 748 suspected TB patients were tested at Linyi People＇s Hospital from September to December in 2016. Each specimen was subjected to 2 direct smear slides. One slide was stained by fluorescence method and read with conventional fluorescence micros- copy （FM） manually. Another slide was stained and scanned by AFSS. All the specimens were decontaminated by 4% NaOH and then inoculated into Lowenstein-Jensen （L-J） media for comparison. The performance of AFSS was analyzed compared with culture. All discrepancy slides between AFSS and conventional FM were rechecked by Ziehl- Neelsen microscopy. Results The average positive rate of AFSS was 32.1% while the average positive rate of conventional FM was 31.92%. No significant difference was observed （χ2=0. 016, P〉0.05）. Compared to cul ture, the sensitivity and specificity of AFSS for detecting Mycobaeteria was 83.4%and 95.9%, respectively. The positive predictive value and negative predictive value was 91.6% and 91.4%, respectively. Conclusion AFSS can detect Tuberculosis with high sensitivitv, specificity and automation. and deserve to be promoted.